20 October 2017
Cassio Surgery provides primary medical services to approximately 2,500 patients from Colne House, Watford, Hertfordshire. The practice moved into the current premises in 2014 and is part of a team which includes three single handed GP practices also based at the same location. A merger between the four practices is planned to take place in 2017. The practice has a registered manager in place. (A registered manager is an individual registered with CQC to manage the regulated activities provided).
The practice serves a higher than average population of those aged between 25 and 39 years and a lower than average population of those aged from 50 to 85 years and over. The practice has a diverse patient population and high levels of social deprivation within the local area.
The clinical team includes a female team of two GP partners, one salaried GP and one regular locum GP. Patients are able to see a male GP based at the same location. The practice team works across the four GP practices in Colne House and consists of a minor illness nurse, a practice nurse, a health care assistant, a practice manager, four members of the secretarial team and nine members of the administration and reception team.
The practice is open to patients between 8am and 6:30pm Monday to Friday. Appointments with a GP are available from 8.30am to 11am and from 3.30pm to 6.30pm daily. Emergency appointments are available daily. The practice is a member of Watford Care Alliance and this service enables the practice to offer appointments to patients during extended opening hours at a number of practices across the locality.
Home visits are available to those patients who are unable to attend the surgery and the Out of Hours service is provided by Herts Urgent Care and can be accessed via the NHS 111 service. Information about this is available in the practice and on the practice website.
20 October 2017
Letter from the Chief Inspector of General Practice
We carried out an announced comprehensive inspection at Cassio Surgery on 7 September 2017. Overall the practice is rated as good.
Our key findings across all the areas we inspected were as follows:
- There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
- The practice had clearly defined and embedded systems to minimise risks to patient safety.
- Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
- Patient comments highlighted that they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
- Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
- Patients we spoke with said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
- The practice had good facilities and was well equipped to treat patients and meet their needs.
- There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
- The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
The areas where the provider should make improvements are:
- Continue to encourage patients to attend cancer screening programmes.
Professor Steve Field (CBE FRCP FFPH FRCGP)
Chief Inspector of General Practice
20 October 2017
The practice is rated as good for the care of people with long-term conditions.
- Nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
- Performance for diabetes related indicators was comparable with the local CCG and national average. The practice had achieved 93% of the total number of points available, compared to the local average of 90% and national average of 90%.
- 72% of patients diagnosed with asthma, on the register, had received an asthma review in the last 12 months which was comparable to the local average of 75% and national average of 76%.
- Longer appointments and home visits were available when needed.
- All patients with a long-term condition had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
- The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
- There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
20 October 2017
The practice is rated as good for the care of families, children and young people.
- There were systems in place to identify and follow up children living in disadvantaged circumstances and identified as being at possible risk, for example, children and young people who had a high number of A&E attendances.
- Immunisation rates were relatively high for standard childhood immunisations.
- The practice’s uptake for the cervical screening programme was 78%, which was comparable to the local average of 82% and national average of 81%.
- Appointments were available outside of school hours and the premises were suitable for children and babies.
- The practice offered a range of family planning services. The practice worked with midwives, health visitors and school nurses in the provision of ante-natal, post-natal and child health surveillance clinics.
- Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
20 October 2017
The practice is rated as good for the care of older people.
- Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
- The practice offered proactive, personalised care to meet the needs of the older patients in its population.
- The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
- The practice identified at an early stage older patients who may need palliative care as they were approaching the end of their life.
- GPs involved older patients in planning and making decisions about their care, including their end of life care.
- The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
- Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.
- The practice worked closely with a local Rapid Response Team (a model of community care delivering an integrated service combining health, social and mental health).
- The practice provided an annual review for patients aged over 75 years and had reviewed 99% of this population group within the previous 12 months.
20 October 2017
The practice is rated as good for the care of working age people (including those recently retired and students).
- The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
- The practice was able to offer appointments to patients during extended opening hours at a number of practices across the locality.
- The practice carried out routine NHS health checks for patients aged 40 to 74 years.
- The practice was proactive in offering online services repeat prescriptions, communication using e-mail and an appointment reminder text messaging service, as well as information about a full range of health promotion and screening that reflects the needs of this age group.
- Unverified data from the practice showed:
- 81% of patients aged 60 to 69 years had been screened for bowel cancer in the last 30 months compared to the local and national average of 58%.
- 58% of female patients aged 50 to 70 years had been screened for breast cancer in the last three years which was below the local average of 72% and national average of 73%.
20 October 2017
The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).
- The practice carried out advance care planning for patients living with dementia.
- 86% of patients diagnosed with dementia had their care reviewed in a face to face meeting in 2015/2016, which was comparable to the local average of 85% and national average of 84%.
- The practice held a register of patients experiencing poor mental health and offered regular reviews and same day contact.
- Performance for mental health related indicators was comparable with the local CCG and national average. The practice had achieved 94% of the total number of points available, compared to the local average of 95% and national average of 96%.
- The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
- The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
- The practice referred patients to the Improving Access to Psychological Therapies (IAPT) team and encouraged patients to self-refer.
- The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
- Staff we interviewed had a good understanding of how to support patients with mental health needs and dementia.
20 October 2017
The practice is rated as good for the care of people whose circumstances may make them vulnerable.
- The practice held a register of patients living in vulnerable circumstances including those with a learning disability. Staff worked closely with the local Learning Disability Liaison Nurse. There were nine patients on the practice’s learning disability register at the time of our inspection. Of those, eight had been invited for and six (75%) had accepted and received a health review in the past 12 months.
- The practice offered longer appointments for patients with a learning disability.
- The practice regularly worked with other health care professionals in the case management of vulnerable patients.
- End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
- Vulnerable patients had been told how to access support groups and voluntary organisations.
- Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.
- The practice held a register of carers with 58 carers identified which was approximately 2% of the practice list. The practice displayed information on a carers’ notice board.